Homeopathy

Does it work?

Systematic reviews

A systematic review of systematic reviews of homeopathy conducted in 2002 concluded that there is no evidence from systematic reviews that homeopathy is effective beyond placebo for any condition.16 A 2009 Cochrane review was aimed at evaluating “the effectiveness and safety of homeopathic medicines used to prevent or treat adverse effects of cancer treatments".17 The authors found eight controlled clinical trials: three studied adverse effects of radiotherapy, three studied the adverse effects of chemotherapy and two investigated menopausal symptoms due to breast cancer therapy. One rigorous study of Calendula extract ointment (n=254) suggested benefit for the prevention of radiotherapy-induced dermatitis compared to controls treated with trolamine.18 Another small (n=32) yet rigorous study found that Traumeel S mouthwash (a complex homeopathic remedy) was better than placebo for chemotherapy-induced stomatitis.19 The other trials were either methodologically weak or had negative results. Neither of the two positive studies employed high dilutions; thus their effects might be explicable through the pharmacological properties of their ingredients.

Clinical trials

In 2012, Sencer et al published a multi-center, double-blind, randomized trial comparing Traumeel with placebo in paediatric cancer patients suffering from mucositis.20 Traumeel or placebo were applied a five-time daily as a mouth rinse. The efficacy of the treatments was assessed using the modified Walsh scale for mucositis, scored daily from Day -1 to 20 days. The main outcome was the sum of Walsh scale scores over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no significant inter-group difference in any outcome measure.

These findings seem to tie in with those from a recent non-randomised, controlled clinical trial with patients suffering from radiation-induced mucositis. The participants were 20 patients who were receiving radiotherapy or radiochemotherapy for head and neck tumours. Five times per day during the observational period, participants self-administered daily mouth rinses with either sage tea (Salvia officinalis, control group) or Traumeel S solution (intervention group). Two independent physicians determined the grade of oral mucositis at least once per week, and the research team derived the degree of oral pain from diaries that participants kept. Both groups were comparable in terms of tumour and treatment characteristics. The research team could not confirm any appreciable specific effect of Traumeel S on the primary endpoints.21

Perol et al published a randomized, placebo-controlled trial to evaluate the efficacy of a complex homeopathic medicine, Cocculine ( main homeopathic ingredient = nux vomica), in the control of CINV in non-metastatic breast cancer patients treated by standard chemotherapy regimens.22 The primary endpoint was nausea score measured after the 1st chemotherapy course using the FLIE questionnaire (Functional Living Index for Emesis) with 5-day recall. Secondary endpoints were: vomiting measured by the FLIE score, nausea and vomiting measured by patient self-evaluation (EVA) and investigator recording (NCI-CTC AE V3.0) and treatment compliance. In total, 431 patients were randomized: 214 to Cocculine (C) and 217 to placebo (P).There was no difference between the 2 arms when primary endpoint analysis was performed by chemotherapy stratum; or in the subgroup of patients with susceptibility to nausea and vomiting before inclusion. In addition, nausea, vomiting and global emesis FLIE scores were not statistically different at any time between the two study arms.

The most recent trial was a pragmatic RCT in which 410 patients with various types of cancer were randomised to receive classical homeopathy in addition to standard anti-cancer treatment or standard treatment alone.23 Homeopathy treatment was individually tailored to each patient. The main outcome measures were global health status and subjective wellbeing. Improvements in both were recorded in the homeopathy group based on questionnaires completed at baseline and the two follow-up visits at intervals of two months. At least one outcome measurement was obtained for 373 patients. The improvement in global health status between visits 1 and 3 was significantly greater in the homeopathy group by 7.7 (95%CI 2.3—13.0, p = 0.005) when compared with the control group. A significant difference was also reported for subjective wellbeing (14.7 95% CI 8.5—21.0, p < 0.001. A significant improvement in subjective was seen in the control patients between the first and third visits. This was a well-designed, rigorous study with adequate randomisation and allocation concealment, and procedures for dealing with missing data. However, the lack of a control intervention and consequent lack of blinding combined with patient-reported subjective outcome measures, mean that the risk of bias is high.

Other studies

A 2011 prospective cohort study compared cancer patients who had opted for homeopathic treatments as an adjunct to conventional cancer therapies with patients who had chosen to have onventional care only.24 Matched pairs were formed of patients with the same cancer type and prognosis. Encouraging effects in terms of fatigue and quality of life were noted after three months. It is unclear, however, whether the outcome was a result of the treatment or due to selection bias as this was an observational study.

Citation

Document history

Last updated and revised in July 2016 by Karen Pilkington.
Updated in May 2013 by Edzard Ernst.
Updated and revised in November 2011 by Edzard Ernst.First published in June 2010, authored by Edzard Ernst.

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